Parental and Adolescent Positive Affect and Optimism as Predictors of Postsurgical Mood and Functioning in Adolescents Undergoing Spinal Fusion Surgery.

SP35 Transitional pain and prevention of pain chronification

Potential role for immune cell signatures as predictors of acute and chronic pain in adolescents post major musculoskeletal surgery.

Assessment of the efficacy and safety of perioperative intravenous ketamine in reducing incidence and severity of chronic postsurgical pain. A systematic review and meta-analysis of randomized controlled trials (RCTs). The following data sources were systematically searched: MEDLINE, CENTRAL, and EMBASE (till 02/2021). Adult patients undergoing any surgery. Perioperative use of intravenous ketamine as an additive analgesic drug compared to placebo, no active control treatment, and other additive drugs. Primary outcomes were number of patients with chronic postsurgical pain after 6 months and ketamine related adverse effects. Secondary outcomes were chronic postsurgical pain incidence after 3 and 12 months, chronic postsurgical neuropathic pain incidence, chronic postsurgical moderate to severe pain incidence, intensity of chronic postsurgical pain at rest, and during movement, oral morphine consumption after 3, 6, and 12 months and incidence of opioid-related adverse effects. Thirty-six RCTs were included with a total of 3572 patients. Ketamine compared to placebo may result in no difference in the number of patients with chronic postsurgical pain after 6 months (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.71-1.05; I2 = 34%; 16 studies; low-certainty evidence). Ketamine may reduce the incidence of chronic postsurgical neuropathic pain after 3 months in comparison to placebo (RR 0.78, 95% CI 0.62-0.99, I2 = 31%, seven trials, low-certainty evidence). Ketamine compared to placebo may increase the risk for postoperative nystagmus (RR 9.04, 95% CI 1.15-70.90, I2 30%, two trials, low-certainty evidence) and postoperative visual disturbances (RR 2.29, 95% CI 1.05-4.99, I2 10%, seven trials, low-certainty evidence). There is low-certainty evidence that perioperative ketamine has no effect on chronic postsurgical pain in adult patients. Low-certainty evidence suggests that ketamine compared to placebo may reduce incidence of chronic postsurgical neuropathic pain after 3 months. Questions like ideal dosing, treatment duration and more patient-related outcome measures remain unanswered, which warrants further studies. Prospero CRD42021223625, 07.01.2021.

Pain ManagementVol. 8, No. 5 EditorialAcute neuropathic pain and the transition to chronic postsurgical painAlexander SchnabelAlexander Schnabel*Author for correspondence: Tel.: 0049-251-830; E-mail Address: alexander.schnabel@ukmuenster.de Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Albert-Schweitzer Campus 1A, 48149 Muenster, Germany Department of Anaesthesiology, University Hospital of Wuerzburg, Oberdürrbacherstr. 6, 97080 Würzburg, GermanySearch for more papers by this authorPublished Online:3 Oct 2018https://doi.org/10.2217/pmt-2018-0026AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInReddit View articleReferences1 Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromsøstudy. 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Pain Res. 8, 695–702 (2015).Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited ByAnalgesia after Labor and Cesarean Section: Chronic Pain after PregnancyFamilial Episodic Pain Syndromes1 August 2022 | Journal of Pain Research, Vol. Volume 15A systematic review on diagnostic test accuracy of magnetic resonance neurography versus clinical neurosensory assessment for post-traumatic trigeminal neuropathy in patients reporting neurosensory disturbance27 May 2020 | Dentomaxillofacial Radiology, Vol. 18Pain Management and the Urology Patient1 August 2020Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery1 March 2020 | Medicine, Vol. 99, No. 13 Vol. 8, No. 5 Follow us on social media for the latest updates Metrics Downloaded 173 times History Received 7 May 2018 Accepted 5 June 2018 Published online 3 October 2018 Published in print September 2018 Information© 2018 Future Medicine LtdFinancial & competing interests disclosureThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download

(1) Characterize objective physical activity patterns via actigraphy over 4 months postspinal fusion surgery, and (2) examine associations between activity patterns at 2-week and chronic postsurgical pain (CPSP) status at 4 months. Data from 109 youth (10 to 18 y) who underwent spinal fusion surgery at a children's hospital in the Northwestern United States were analyzed. Youth completed questionnaires and actigraphic assessment of physical activity presurgery, and 2 weeks and 4 months postsurgery. Eighteen percent of youth developed CPSP at 4 months. Presurgery physical activity was similar for youth with and without CPSP. At 2 weeks postsurgery, daily activity levels were lower for youth who developed CPSP as compared with those who did not, including lower mean activity (168 vs. 212 counts/min, P=0.01), fewer activity bouts (n=1.7 vs. 2.6, P=0.02), and shorter bout duration (27 vs. 40 min, P=0.02). Differences in activity were maintained at 4 months such that youth with CPSP had lower mean activity (284 vs. 334 counts/min, P=0.03), as well as greater proportion time spent sedentary and lower proportion time in light activity than youth without CPSP. In adjusted models examining 2-week actigraphy as a predictor of 4-month pain status, mean activity (odds ratio=0.99, P=0.04) and number of activity bouts (odds ratio=0.79, P=0.02) were associated with subsequent CPSP status over and above 2-week pain intensity. Lower activity engagement during the initial weeks following spinal fusion surgery was associated with development of CPSP, suggesting early physical activity limitations as a risk factor for CPSP in youth. Understanding recovery patterns is critical for identifying those at risk for chronic pain and implementing early interventions.

About 1 in 5 adolescents undergoing major surgery develops chronic postsurgical pain. Various risk and resilience factors for recovery and chronic postsurgical pain have been identified, including parental characteristics. However, research commonly relies on nomothetic data, whereas psychometric properties of diaries assessing pediatric postsurgical recovery in everyday life are understudied. This study aimed to evaluate preliminary reliability, validity, and variability of diary data in adolescents and their parents after spinal fusion surgery. Adolescents with idiopathic scoliosis undergoing spinal fusion surgery and their parents were asked to complete daily diaries for 7 consecutive days at 5 time points: before surgery and 3 weeks, 6 weeks, 6 months, and 12 months after surgery. Diaries were developed based on validated questionnaires measuring relevant constructs of pediatric postsurgical recovery. Internal consistency; test-retest reliability; convergent, divergent, and concurrent criterion validity; and variability were examined. The sample comprised 95 adolescents and 95 parents. Overall compliance rate was approximately 80% in both adolescents and parents, with a total of 5282 diary entries analyzed. Internal consistency for multi-item variables ranged from good to excellent (α= 0.82-0.93) for adolescent data and acceptable to excellent (α= 0.74-0.93) for parent data. All test-retest correlations were significant-large (ρ= 0.60-0.76) for adolescent data and medium to large for parent data (ρ= 0.57-0.80). Regarding validity, all but 3 correlations between diary variables were significant. Diary variables generally correlated significantly with corresponding questionnaire data. Variability was low in some variables. These results provide evidence for psychometric properties regarding reliability, validity, and variability of diaries monitoring processes of postsurgical recovery in everyday life in adolescents undergoing spinal fusion surgery. Replication is suggested for refinement and further validation, with particular attention to variability and evaluation of sensitivity to change.

The Impact of Dorsal Root Ganglion Stimulation on Pain Levels and Functionality in Patients With Chronic Postsurgical Knee Pain

The efficacy of perioperative pregabalin treatment for preventing chronic pain remains a matter of debate. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases, and other sources, for randomized controlled trials comparing the effects of pregabalin and placebo. The primary outcome was the incidence of chronic postsurgical pain (CPSP) at 3 months. The secondary endpoints were CPSP at 3, 6, and 12 months and the incidence of chronic postsurgical neuropathic pain at the same time points. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the GRADE method. We included 18 studies (2485 patients) in the meta-analysis. Overall, 60% of the trials reporting the primary outcome at 3 months were unpublished; the unpublished trials corresponded to 1492/1884 (79%) of the patients included in these studies. No difference in CPSP incidence between pregabalin and placebo was found at any time point; the risk ratio was 0.87 (0.66, 1.14), I = 57% at 3 months. The evidence was considered to be of moderate quality. Subgroup analysis by publication status, daily dose, type of administration, and type of surgery did not highlight any differences between subgroups. Insufficient data concerning the incidence of chronic postsurgical neuropathic pain were available for any firm recommendation to be made. Pooled data from published and unpublished studies provide no support for the efficacy of pregabalin for preventing CPSP.

Cross-sectional study. Patients who undergo intramedullary spinal surgery occasionally experience post-surgical chronic pain; however, the underlying mechanisms are not yet completely understood. Therefore, this study aimed to identify the cerebral structural changes in patients with post-surgical chronic myelopathic pain using voxel-based morphometry. Single university hospital in Tokyo, Japan. Forty-nine patients who had undergone intramedullary spinal surgery between January 2002 and April 2014 participated in this study. Participants were classified into two groups based on their post-surgical chronic pain intensity: control (numeric rating scale score of <3) and pain (numeric rating scale score of ≥3) groups. We compared pain questionnaire and brain MRI between two groups. Brain MRI data of each participants was analyzed using voxel-based morphometry. Voxel-based morphometry revealed that the gray matter volume in the left supplementary motor area, left primary motor area, and left posterior cingulate cortex was higher in the pain group than that in the control group. In addition, the numeric rating scale score was significantly correlated with increased gray matter volume in the left primary motor area, left posterior cingulate cortex, and right superior parietal lobule. Present study elucidates the characteristic cerebral structural changes after an intramedullary spinal surgery using voxel-based morphometry and indicates that the structural changes in specific cerebral areas are associated with post-surgical chronic myelopathic pain.

The role of cytokines in acute and chronic postsurgical pain after major musculoskeletal surgeries in a quaternary pediatric center

Objective:Chronic post surgical pain (CPSP) occurres frequently (from 10% to 50%) and has serious effects on the mood and activities of patients. This study was designed to evaluate the relationship between acute post surgical pain and chronic post surgical pain.Methods:Electronic search databases included PubMed, EMBASE, Cochrane database and web of science. 9-stars Newcastle-Ottawa Scale was used to evaluate the quality of included studies. The odds ratio was used as a summary statistic index. Heterogeneity was assessed with I2.Results:We collected data from 4 case-control studies with or without chronic post surgical pain and compared those with patients who had acute post surgical pain or not. The age, sex was controlled as confounding factors. We collected 765 patients with chronic post surgical pain, of which 38.82% used to have acute post surgical pain. The risk ratio of patients with acute post surgical pain, as compared with no acute post surgical pain, was 3.10 for chronic post surgical pain (95% CI: 2.44, 3.96).Conclusion:Acute post surgical pain is a rick factor for chronic post surgical pain. We need to pay much attention to this phenomenon. However, more studies with high quality were still needed to confirm these findings.

Dexketoprofen/tramadol is a fixed-dose multimodal combination analgesic that significantly controls multiple acute pain states, and may have an important clinical application in providing pain control adequate to prevent the transition from acute to chronic postsurgical and low back pain. A consensus is needed to quantify and define the actual burden of postsurgical pain (PSP) and low back pain (LBP), which can support efforts toward effective approaches to manage potential pain chronification. This study utilized a modified Delphi approach. A Scientific Committee set forth 28 statements on six themes about the burden of acute PSP and LBP, their potential transition to chronic pain, their pathophysiology, therapeutic approaches to stop this transition, and the role of multimodal analgesia in this context, specifically a fixed-dose combination oral product of dexketoprofen/tramadol. An international panel of healthcare professionals from various regions and relevant medical specialties participated in a Delphi study and were surveyed for consensus on a 5-point Likert scale with consensus defined as > 70% concordance. A round of online voting lasting 3months and using an online survey platform was permitted for each participant. A total of 100 experts completed the Delphi survey. All the 28 proposed statements reached consensus > 70% in the first round of voting. A fixed-dose combination product, specifically dexketoprofen/tramadol was recognized as a multimodal analgesic which could effectively relieve acute pain and act to prevent its transition to chronic pain. The high global burden of chronic PSP (CPSP) and chronic LBP (CLBP) was identified as well. Healthcare professionals who deal with pain recognize the burden of acute pain, the risks of acute pain transitioning to chronic pain, and inspire to avert the transition by providing effective multimodal control of acute pain. The role of fixed-dose combination analgesics, in particular dexketoprofen/tramadol, was recognized by consensus as an efficacious and safe therapy option for these acute pain syndromes. A Video Abstract is available for this article. To view, please see the online version of the manuscript or follow the 'Digital Features' link. A Video Abstract for The Role of Dexketoprofen/Tramadol in Multimodal Therapy to Prevent Acute Postsurgical and Acute Low Back Pain from Developing into Chronic Pain: A Delphi Consensus Study (MP4 112565 KB).

The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking. This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section. Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis. We searched MEDLINE to May 2015. We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain. Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months. Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain. This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.

Chronic postsurgical pain (CPSP) affects 20% to 30% of pediatric patients at 12 months after surgery. We hypothesized that differences in biopsychosocial and somatosensory profiles exist between patients with CPSP and those with chronic primary pain (CPP) and that these differences affect treatment outcomes. This cohort included prospectively collected, retrospectively analyzed data from adolescents treated at the Edwards Family Interdisciplinary Center for Complex Pain between May 2016 and May 2022. During clinic intake, patients completed the Functional Disability Inventory, Revised Child Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index to assess for disability, anxiety, depression, and sleep quality, respectively. Baseline quantitative sensory testing/conditioned pain modulation (QST/CPM) was performed to characterize somatosensory functioning. The primary outcome was a score of 6 ("much better") or 7 ("very much better") on the Patient Global Impression of Change (PGIC) measure at treatment end. Of 99 patients (14.8 ± 2.0 years, 90% female), 46 had CPSP and 53 had CPP. Compared to CPP, patients with CPSP had less baseline functional disability, coexisting depression, and social phobia and better sleep quality. After adjusting for psychosocial differences, patients with CPSP were more likely to score ≥6 on PGIC than patients with CPP (odds ratio = 3.0 [95% confidential interval: 1.3-7.7], P = 0.01). Patients with dynamic mechanical allodynia and/or temporal summation were less likely to score ≥6 on PGIC compared to patients without (odds ratio = 0.33 [95% confidential interval: 0.13-0.82], P = 0.02). Differences in biopsychosocial factors, somatosensory profiles, and treatment outcomes exist between patients with CPSP and CPP. The presence of centrally driven pain hypersensitivity on baseline QST/CPM was associated with worse recovery prognosis.

Study DesignThis is a retrospective observational study with an outpatient setting.PurposeThis study aimed to describe the effects of duloxetine (DLX) administration for postsurgical chronic neuropathic disorders (both pain and numbness) following spinal surgery in patients without depression.Overview of LiteratureAlthough several reports indicated the potential of DLX to effectively treat postoperative symptoms as a perioperative intervention, there have been no reports of its positive effect on postsurgical chronic neuropathic disorders.MethodsA total of 24 patients with postsurgical chronic pain and/or numbness Numeric Rating Scale (NRS) scores of ≥4 were enrolled. All patients underwent spine or spinal cord surgery at Keio University Hospital and received daily administration of DLX for more than 3 months. The mean postoperative period before the first administration of DLX was 35.5±57.0 months. DLX was administered for more than 3 months at a dose of 20, 40, or 60 mg/day, and the degree of pain and numbness was evaluated using the NRS before administration and 3 months after administration. Effectiveness was defined as more than a 2-point decrease in the NRS score following administration.ResultsIn terms of the type of symptoms, 15 patients experienced only numbness, eight experienced both pain and numbness, and one experienced only pain. Of the 24 patients, 19 achieved effective relief with DLX. DLX was effective for all patients with postsurgical chronic pain (n=9), and it reduced postsurgical chronic numbness in 18 of 23 patients. No significant difference was observed in background spinal disorders. DLX was not effective for five patients who complained only of postsurgical chronic numbness.ConclusionsThis study reports the effectiveness of DLX for postsurgical chronic neuropathic disorders. Although DLX reduced postsurgical chronic pain (efficacy rate=100%) and numbness (78.3%) in certain patients, further investigation is needed to determine its optimal use.